Since 1996 I have been researching and developing the Addiction-Free Pain Management® System to help address the growing problem of chronic pain management being untreated or undertreated. 

In order to be more effective I have joined a number of pain management organizations in order to have better access to quality research. Today I wanted to revisit how serious this problem of undertreated or mismanaged chronic pain management is becoming and review some ideas for improvement. 

Below are the suggestions from a June 2009 meeting of the Mayday Fund that I welcome and believe are necessary. Please especially note their closing conclusion. To learn more, please check out the Mayday Fund’s complete report  A Call to Revolutionize Chronic Pain Care in America: An Opportunity in Health Care Reform.

1.  Every American who suffers from chronic pain should have 24/7 access to access to a well-trained primary care provider who can offer—and coordinate—pain care that is high quality, equitable, and cost-effective.

2.  Every American with chronic pain who needs sophisticated or high-tech treatment, or whose pain has not responded to best practices in the primary care setting, should have access to evaluation and treatment by a pain medicine specialist.

3.  Every patient should expect to have pain managed in a manner that translates best evidence into appropriate treatments, and then coordinates these treatments into a plan that is likely to be effective in controlling symptoms and promoting function, while minimizing the risks associated with treatment. At the same time, such a plan should reduce the costs associated with duplicative and ineffective treatments.

4.  Government, health care payors, and health care providers should develop and utilize coordinated health information technology (IT) systems to track pain disorders, treatments, and outcomes as a mechanism to improve pain care. Quality indicators and performance measures should be developed and applied, and the public should gain access to information on the performance of hospitals, doctors and other health care providers.

5.  State medical and osteopathic boards, deans of medical and other health professional schools, directors of residency training programs in specialties and subspecialties that provide primary care, professional societies and other stakeholders should make sure that every trainee and health practitioner in the health professions has the skills to assess and treat pain effectively, including chronic pain. Licensing examinations should include assessment of clinical knowledge related to appropriate pain care.

6.  The Health Resources and Services Administration (HRSA) should expand funding for pain training programs that address competencies in pain assessment and management aimed at pediatric and adult primary care physicians, as well as other health professionals who manage pain, such as nurses, pharmacists, psychologists, physical therapists, social workers and other providers.

7.  The Department of Health and Human Services (HHS) should establish an independent commission to reform the reimbursement practices for chronic pain. At present, Medicare and Medicaid maintain fee for service systems that incentivize procedures and inadequately compensate professionals for the time required to assess, counsel and educate, and coordinate the care of chronic illnesses like persistent pain. This commission should explore outcome-based payments for a team approach for selected cases, revision of the disparity between non-procedural and procedural pain treatments, and parity for mental health services. Ongoing complex chronic pain management should be treated, when possible, with an interdisciplinary, rehabilitation-oriented, team approach with reimbursement for the team, rather than fee-for-service for specific individuals within the team.

8.  The National Institutes of Health (NIH) should increase funding for pain research to a level that is commensurate with the size of a public health problem that affects millions of people. The research should put an emphasis on emerging therapies and translational research, comparative effectiveness trials, bio-behavioral treatments, and health services research, as well as basic science. More research should focus on ways to prevent acute pain from developing into a chronic illness and to prevent childhood chronic pain from becoming a lifelong condition.

9.  The Agency for Healthcare Research and Quality (AHRQ) should expand funding for studies aimed at finding a set of best practices that could be used to treat specific types of chronic pain. Providers and policymakers could use such information to develop and promote high quality pain management models.

10.  The U.S. Surgeon General should make public education about pain, especially chronic pain, a high priority. Such a campaign could educate the public about the risks of untreated and undertreated pain in children and adults as well as promote preventive strategies that can enhance wellness and reduce the risk for the development of chronic pain.

11.  Health care providers, insurers and government should work to eliminate disparities in access to pain care related to race, ethnicity, gender, age (e.g. children and the elderly), and socioeconomic status so that chronic pain for all individuals in need is recognized and treated without delay.

12.  Federal, state and local agencies should publicly adopt a balanced approach to the regulation of controlled prescription drugs, particularly opioids. The clinical decisions of prescribers should not be inappropriately influenced by fear of regulatory scrutiny. Research has shown that state laws continue to harbor requirements that are outdated or reflect poor medical practice. A balance must be achieved between the legitimate need to protect public safety and public health through efforts to reduce drug abuse and diversion, and the imperative to address the public health problem of unrelieved pain. Policies and actions intended to reduce abuse or diversion must also include a comprehensive public analysis of these actions on access to quality and equitable pain care, including access to medications required for legitimate pain management.

Conclusion

Reducing the burden of uncontrolled chronic pain is a societal necessity, a medical challenge and an economic requirement. Chronic pain, if not recognized and treated as a chronic illness, takes an enormous personal toll on millions of patients and their families, and leads to increased health care costs. Chronic pain can also compromise the productivity of the U.S. workforce. Although the impact of pain on patients and on society is among the most serious of public health concerns, chronic pain has been largely left out of the current national debate on health reform. The nation must take the necessary steps to re-define chronic pain as a unique chronic illness and must immediately address this public health crisis.

To learn more about effective chronic pain management check out my article The Need for Multidisciplinary Chronic Pain Management that you can download for free on our Articles page.

You can learn about the Addiction-Free Pain Management® System at our website www.addiction-free.com. If you are working with people undergoing chronic pain management and want to learn how to develop a plan for managing their chronic pain and coexisting psychological disorders; including depression, addiction and other coexisting psychological disorders effectively; please consider my book Managing Pain and Coexisting Disorders: Using the Addiction-Free Pain Management® System. To purchase this book please Click Here.

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